Differences in different reconstruction algorithms for coronary CTA demonstrating pericoronary adipose tissue attenuation

Q: What does this research mean for the field?

The Fat Attenuation Index (FAI) measured by DLIR-H is significantly higher than that measured by ASiR-V50% and FBP in coronary CTA (p < 0.05). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate differences in coronary Fat Attenuation Index (FAI), image noise, and pericardial fat attenuation measured on coronary CTA using three distinct image reconstruction algorithms.

Yuxuan Zhu; Jiajie Zhu; Xin Ding; Yingying Ge; Dejiong Liu; Hongbing Ma

doi:10.1038/s41598-025-28914-6

December 29, 2025Scientific ReportsOpen Access

Differences in different reconstruction algorithms for coronary CTA demonstrating pericoronary adipose tissue attenuation

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Key result

The Fat Attenuation Index (FAI) measured by DLIR-H was significantly higher than that measured by ASiR-V50% and FBP in coronary CTA (p < 0.05).

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Why the study?

The study aimed to evaluate differences in coronary Fat Attenuation Index on CCTA across three different image reconstruction algorithms.

Does the choice of CCTA reconstruction algorithm affect the measurement of coronary Fat Attenuation Index (FAI) in patients undergoing CCTA?

Key Points

To evaluate differences in coronary Fat Attenuation Index (FAI), image noise, and pericardial fat attenuation measured on coronary CTA using three distinct image reconstruction algorithms.
Analyzed 773 patients (mean age 56 ± 14 years; 452 male [58.58%], 321 female [41.52%]) categorized by plaque presence: normal (n=165), no plaque (n=212), non-calcified plaque (n=143), mixed plaque (n=134), and calcified plaque (n=119).
Compared three reconstruction algorithms under identical tube voltage: high-level Deep Learning Image Reconstruction (DLIR-H), adaptive statistical iterative reconstruction-Veo at 50% (ASiR-V50%), and Filtered Back Projection (FBP).
Measured attenuation of proximal coronary arteries, pericardial adipose tissue, image noise, and FAI in the right coronary, left anterior descending, and left circumflex arteries.
FAI differed significantly across algorithms in all plaque groups and coronary branches (all P < 0.001), with DLIR-H yielding the highest values, followed by ASiR-V50%, and FBP the lowest (e.g., normal: -76.2 ± 6.4 HU vs -78.8 ± 6.3 HU vs -83.4 ± 5.9 HU; calcified plaque: -74.6 ± 6.4 HU vs -77.8 ± 6.1 HU vs -83.4 ± 5.9 HU).
Image noise was significantly reduced by DLIR-H compared to ASiR-V50% and FBP across all plaque groups (all P < 0.001), measuring 15.7 ± 3.1 HU vs 27.9 ± 5.9 HU vs 38.1 ± 7.6 HU in normal participants and 16.7 ± 2.9 HU vs 30.5 ± 6.3 HU vs 41.6 ± 7.3 HU in calcified plaque.
Pericardial fat attenuation (e.g., normal: -91.4 ± 14.9 HU for DLIR-H, -92.1 ± 14.7 HU for ASiR-V50%, -92.1 ± 14.7 HU for FBP) and coronary artery attenuation showed no significant differences among reconstruction methods (all P > 0.05).

Structured PICO

Does the choice of CCTA reconstruction algorithm affect the measurement of coronary Fat Attenuation Index (FAI) in patients undergoing CCTA?

P

Population

773 patients undergoing Coronary Computed Tomography Angiography (CCTA), mean age 56, 58.58% male. Excluded: allergy to iodinated contrast agents, clinical instability, severe hepatic or renal insufficiency, and prior stent implantation or coronary artery bypass grafting.

I

Intervention

CCTA image reconstruction using high-level Deep Learning Image Reconstruction (DLIR-H), adaptive statistical iterative reconstruction-Veo at a level of 50% (ASiR-V50%), and Filtered Back Projection (FBP).

C

Comparator

Intra-patient comparison across the three different reconstruction algorithms.

O

Outcome

Fat Attenuation Index (FAI), image noise, and pericardial fat attenuation values measured across the three reconstruction algorithms.surrogate

Coronary Fat Attenuation Index (FAI) values vary significantly depending on the CCTA reconstruction algorithm used, highlighting the need for standardized protocols to ensure reproducible results in multicenter and longitudinal studies.

Limitations

Single-centre study with a relatively small sample size.
Grouping was based on the presence or absence of coronary plaques; influence across different sexes and plaque types requires further investigation.
Focused solely on the proximal 40 mm segment of the coronary arteries.
Standard tube voltage of 120 kV was used; effect under other tube voltages needs analysis.
Potential influence of body habitus and variation in coronary attenuation values across individuals warrants further investigation.

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Implication

Reconstruction algorithm may alter FAI values; leaves open standardization needs for reproducible research.

Abstract

The Fat Attenuation Index (FAI) surrounding the coronary arteries, a sensitive biomarker for coronary inflammation, can be measured through standard Coronary Computed Tomography Angiography (CCTA). The aim of this study is to evaluate the differences in FAI as displayed on CCTA using three different reconstruction algorithms: high-level Deep Learning Image Reconstruction (DLIR-H), adaptive statistical iterative reconstruction-Veo at a level of 50% (ASiR-V50%), and Filtered Back Projection (FBP). Based on the presence or absence of plaque, the population was divided into the following groups: normal, no plaque, non-calcified plaque, mixed plaque, and calcified plaque. Each group was then further analysed according to the reconstruction algorithm, with three subgroups for each: DLIR-H, ASiR-V50%, and FBP. Attenuation values for pericardial adipose tissue, image noise, and the Fat Attenuation Index (FAI) of the three proximal coronary arteries were measured and evaluated for each of the three reconstruction algorithms. The attenuation values of pericardial adipose tissue measured by the three algorithms were not statistically different. However, the FAI measured by DLIR-H was the highest, followed by ASiR-V50%, with FBP yielding the lowest value; all differences were statistically significant. Meanwhile, DLIR-H demonstrated the strongest ability to reduce image noise, whereas FBP showed the weakest ability to do so. FAI varies significantly depending on the algorithm used. Therefore, standardised reconstruction protocols are essential in multicentre and longitudinal studies to ensure accurate, reproducible, and comparable FAI results.

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Cite This Study

Zhu et al. (2025) studied this question. The Fat Attenuation Index (FAI) measured by DLIR-H was significantly higher than that measured by ASiR-V50% and FBP in coronary CTA (p < 0.05).

synapsesocial.com/papers/6963221691e05aa366cb88d1 https://doi.org/10.1038/s41598-025-28914-6

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Differences in different reconstruction algorithms for coronary CTA demonstrating pericoronary adipose tissue attenuation

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Differences in different reconstruction algorithms for coronary CTA demonstrating pericoronary adipose tissue attenuation

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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